Using Mobile Phone Apps to Deliver Rural General Practitioner Services: Critical Review Using the Walkthrough Method.

backgroundThe widespread use of mobile phones represents new frontiers for improving access to health care. This includes using mobile apps to deliver general practitioner (GP) services in rural areas. However, the wider adoption of apps for increasing access to rural GP services relies on understanding how they might intersect with the rural health system context.

objectiveThis research aims to critically review mobile apps for delivering GP services in a rural health service context using the walkthrough method.

methodsThe sample comprised 3 GP service apps under the top 100 list in the medical category in the Apple App Store (also available via the Google Play Store) in Australia as of June 2020. The walkthrough method was applied to extract data and critique the explicit factors, such as the app interface elements, and implicit factors, such as the embedded cultural features related to use for people in rural settings. Data analysis was undertaken between 3 researchers over 6 months applying the walkthrough method and using critical reflection.

resultsThere were 3 main themes: improving rural access, addressing rural health care needs, and providing quality of care. App-based GP services may improve rural GP service availability. However, this may be at a relatively superficial level that does not encompass the scope and intensity of the services needed in rural areas (including relevant chronic and emergency care) at a cost that rural patients can afford. The apps showed signs of limited tailoring to the cultural dimensions of rural health care as a barrier to rural use. Patients generally self-selected to use GP service apps with limited support, potentially leading to inappropriate uptake especially by disadvantaged groups with lower health literacy. Although the apps claimed to avail most GP services (70%-80% in some cases), it emerged after enrollment that emergency, complex, and serious conditions might be excluded, potentially imposing more complex caseloads on in-person rural GPs. Apps provided limited information about continuity and coordination of care and sharing information with rural GPs, potentially leading to fragmented and low-quality care. There was commonly no assurance of rural skills and experience of physicians staffing apps despite the wider scope of skills needed to be effective in rural general practice.

conclusionsGP apps may increase the availability of GP services, but they may require clearer exclusions, appropriate use through decision-making tools, more rural-tailored interfaces, and capacity to align appointment times and costs with patients with complex needs to engage and be useful in a rural context. It is also important to consider how these app-based services could share information with local health care staff for safety and continuity of rural primary care. Finally, information about the physicians' rural training and experience is critical for quality.